Healthcare Provider Details

I. General information

NPI: 1417811381
Provider Name (Legal Business Name): WILSON THERAPEUTIC TOUCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 FLYNT DR STE 440
FLOWOOD MS
39232-9736
US

IV. Provider business mailing address

117 TRAILBRIDGE WAY
CANTON MS
39046-6063
US

V. Phone/Fax

Practice location:
  • Phone: 770-283-4643
  • Fax:
Mailing address:
  • Phone: 770-283-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: TORRIS WILSON
Title or Position: OWNER
Credential:
Phone: 770-283-4643